There is a considerable association between major depressive disorder (MDD) and cardiovascular disease, most possibly relying on abnormalities in the autonomic nervous system (ANS)-related cardiac reactivity, although the exact underlying pathophysiological pathway is unclear.

This study tends to shed some additional light on this background by investigating ANS reactivity in MDD with respect to previous depression history through an objective stress challenge paradigm.

The study assessed the effects of an overnight hypothalamus-pituitary-adrenal (HPA) axis stimulation with metyrapone (MET) on baseline ANS activity through linear and non-linear heart rate variability (HRV) measures in the morning of two continuous days in a group of 14 physically healthy, antidepressant-free patients with clinical, non-psychotic MDD, to investigate differences in autonomic reactivity with respect to prior MDD history.

The main findings of this study include statistically significant time x group interactions with respect to several HRV measures, suggesting substantial differences on autonomic reactivity between patients with and without depression history. Hereby, recurrent-episode MDD patients showed lower vagal activity, while first-episode MDD patients increased PNS activity after HPA axis stimulation.

These findings indicate that HPA axis stimulation in MDD patients leads to inverse vagal response according to MDD history. We suggest that chronic stress system overactivation, as found in MDD, might lead to a progressive inversion of the original stress response through HPA axis and ANS divergence over the course of a recurrent illness. HRV could, thus, represent a significant biomarker in MDD with temporal sensitivity.

The coronavirus pandemic (COVID-19) has affected the functioning and capacity of healthcare systems worldwide. COVID-19 has also disproportionately affected older adults, including those living with dementia. In the context of COVID-19, decision-making surrounding place of care and place of death in this population involves significant new challenges.

To explore key factors that influence place of care and place of death decisions in older adults. A secondary aim was to investigate key factors that influence the process and outcome of these decisions in older adults. To apply findings from current evidence to the context of COVID-19.

Rapid review of reviews, undertaken using WHO guidance for rapid reviews. Ten papers were included for full data extraction. These papers were published between 2005-2020. Data extracted was synthesised using narrative synthesis, with thematic analysis and tabulation.

Papers included discussed actual place of death, as well as preferred. Results were divided into papers that explored the process of decision-making, and those that explored decision-making outcomes. Factors such as caregiver capacity, the availability of multidisciplinary teams, cultural appropriateness of care packages and advanced care planning were found to be key.

The process and outcomes of decision-making for older people are affected by many factors – all of which have the potential to influence both patients and caregivers experience of illness and dying. Within the context of COVID-19, such decisions may have to be made rapidly and be reflexive to changing needs of systems and of families and patients.

The COVID-19 pandemic presents symptomatic heterogeneity, so the differential diagnosis is even more relevant and more in patients with mental disorders. COVID-19 is a new disease that is under study and affects people over 65 with the greatest severity worldwide. The most frequent psychiatric symptoms are behavioral disturbances and confusional syndrome among those affected.

The objective is to demonstrate the importance of differential diagnosis in patients with psychiatric symptoms and covid-19.

Patients aged 71 and 77, admitted to psychiatry. They present drowsiness that alternates with episodes of psychomotor agitation in which they verbalize fear of the coronavirus. Personal history: bipolar disorder and schizoaffective disorder. Psychopathological exploration: Spatial-temporal disorientation, uncooperative, fluctuating state of consciousness, verborrheic, salty and incoherent speech at times. Dysphoric mood. Psychomotor restlessness predominantly at night, verbal heteroaggressiveness. Negative to ingestion due to odynophagia. Sensory-perceptual alterations and nihilistic delusions “the virus has killed me, I’m already dead.” Upon admission, they present a cough and fever and are treated with azithromycin and dexamethasone for suspected COVID-19. Complementary tests: chest X-ray bilateral pleural effusion. Cranial CT: Diffuse cortical and subcortical brain parenchyma retraction pattern. PCR positive coronavirus.

After overcoming the infection and with psychopharmacological treatment the confusional syndrome remitted.

Confusional syndrome can present with different psychiatric symptoms, so the differential diagnosis is very important and even more so in patients older than 65 years who present somatic pathologies or acute infections. The differential diagnosis of confusional syndrome is key to adequate treatment and favor the prognosis.

Several changes to the classification of schizophrenia and other psychotic disorders have been made to increase the reliability, clinical use and validity of the diagnostic classification which are considered here. A diagnosis of schizoaffective disorder would only be made in ICD-11 when the definitional requirement of schizophrenia is met concurrently with mood symptoms that meet the definitional requirements of a moderate or severe depressive episode, a manic episode, or a mixed episode. This requirement is more restrictive compared to ICD-10, which just required the presence of symptoms of schizophrenia and mood disorder. The total duration requirement would be 4 weeks. A cross-sectional approach was maintained in the ICD-11 for schizoaffective disorders as there is no evidence on how a longitudinal “lifetime” criterion impacts cross-sectional inter-rater reliability, and the reliability of lifetime symptoms’ report by patients and retrospective assessment by clinicians remains unknown.

No significant relationships.

Violence between brothers and / or sisters is one of the most important forms of violence within families. To understand homicides between them, the hypothesis of rivalry has been put forward. But how is it really in reality?

To construct both the clinical and medicolegal profile of perpetrators of fratricide and sororicide.

This is a retrospective study of 12 cases of fratricide, which were examined in the context of criminal psychiatric expertise in the psychiatry department of Hedi Chaker University Hospital in Sfax (Tunisia), between January 2002 and December 2018.

The mean age of offenders was 31.9 years; they were all male. Eight fratricide perpetrators were unmarried and had an irregular occupation. They had a psychiatric follow-up prior to homicide in 5 cases. Previous criminal records were noted in one third of the cases. Three perpetrators of fratricide were using psychoactive substances. History of violence against the victim was presented in 7/12 of cases, and the victim was younger than the perpetrator in 5 cases. Aggression was premeditated in 4 cases. The knife was the most used weapon (11/12). Seven offenders suffered from a major mental illness. The most common diagnosis was schizophrenia (6/12). The experts had concluded that 8 cases were in a state of insanity at the time of the offense.

Our data indicates that fratricides are lack preparation and most often preceded by violence. It seems to be important to do other researches to assess psychopathology and assess risk factors for fratricide.

Postpartum depression (PPD) is the commonest postpartum psychiatric condition, with prevalence rates around 20%1. PPD is associated with a range of adverse outcomes for both the mother and infant2. Therefore, identifying modifiable risk factors for perinatal depression is an important public health issue3.

To explore the role of dysfunctional attitudes towards motherhood in postpartum depressive symptoms and disorder.

247 women were evaluated in the third (12.08±4.25 weeks) and sixth months (31.52± 7.16 weeks) postpartum with the Attitudes Towards Motherhood Scale4, the Postpartum Depression Screening Scale5 and the Diagnostic Interview for Psychological Distress-Postpartum6. Correlation analysis was performed followed by linear/logistic regression analysis when the coefficients proved significant (p<.05), using SPSS.

Dysfunctional beliefs towards motherhood concerning judgement by others and maternal responsibility positively correlated with depressive symptoms at the third (.528; .406) and the sixth months (.506; .492) postpartum. Those dysfunctional beliefs were predictors of depressive symptoms at the third (ß=.440; ß=.151) and sixth months (ß=.322; ß.241) explaining 29.4% and 30.2% of its variance, respectively. Having dysfunctional beliefs at the third month significantly increase the likelihood of being diagnosed with Major Depression (DSM5) both in the third (Wald=9.992, OR=1.169; Wald=16.729, OR=1.231) and sixth months (Wald=5.638, OR=1.203; Wald=7.638, OR=1.301) (all p<.01).

Cognitive distortions should be included in the assessment of risk factors for PPD. Early identification of women presenting motherhood-specific cognitive biases may be crucial for implementing preventive interventions favoring a more positive and healthier motherhood experience.

No significant relationships.

Lock-down restrictions were introduced in most countries of the world at the onset COVID-19 pandemic. It was associated with serious implications for healthcare delivery, with affectation of access to medical services for patients with chronic medical conditions. It is important to assess the impact of this on the subjective feeling of mental wellbeing in these patients.

This study aimed to assess the access to health care services during the lock-down as well the perceived affectation of the mental, physical and social wellbeing and their related factors in patients with chronic illnesses in Ilorin.

This study was a cross-sectional study, involving 166 patients being managed for different chronic medical conditions, attending the Medical Outpatient Clinics of the University of Ilorin Teaching Hospital. A socio-demographic questionnaire and a structured questionnaire designed by the researchers was used.

The mean age of all respondents was 49.5+18.5. 25.3% of respondents were being managed for heart-related conditions. 54 respondents(32.5%) reported a negative affectation of their mental wellbeing, which included changes in mood, sleep pattern and feelings of being overwhelmed and unable to cope properly. The age (p= 0.031) and employment status(p=0.015)of the patient were significantly associated with a subjective feeling of negative affectation of wellbeing.

The impact of the COVID-19 pandemic lockdown on the mental well-being of patients with chronic medical conditions is significant and calls for a more strategic plan for delivery of health care services during pandemic situations with focus on the mental well being of patients.

No significant relationships.

Classic psychedelics have been administered in sacramental contexts since ancient times. They were of prominent interest within psychiatry and neuroscience in the 1950s to 1960s, but the association between classic psychedelics and the emerging counterculture put an end to their research. Modern research with classic psychedelics has reinitiated interest in the treatment of both cancer-related distress and addiction, with really promising results.

We aim to provide a review about history and new insights regarding research with psychedelics specially as treatment of addictive disorders.

A framing analysis of articles, searched on Pubmed (articles between 2010-2020) with the key words: “ psychedelics”, “psilocybin”, “substance use disorder”, “addiction”.

Classic psychedelics are 5HT2AR agonists such as LSD, mescaline, and psilocybin. They were shown to occasion mystical experiences, which are experiences reported throughout different cultures and religions involving a strong sense of unity. These experiences are scientifically important because they appear to cause abrupt and sustained changes in behavior and perception, that can be very useful in the substance use disorder field. From this analysis is possible to understand that the use of psychadelics in the treatment of some addictions is currently at an early stage of research. However, they show interesting results with no clinically significant adverse events when risk individuals are excluded.

In comparison to psychedelic research about cancer-related psychological distress, studies with addictions are less developed, but if they continue to suggest safety and efficacy, may be the use of psilocybin for the treatment of specific addiction can happen in a close future.

Autism spectrum disorders (ASD) is one of the most common neurodevelopmental disorders. It is known that infants who have older siblings with ASD have a risk for development of this disorder. It is important to study the development of children at risk for ASD to reveal early markers for ASD.

The aim of this research was to investigate the neurocognitive abilities in children at risk for ASD at 14 months of age.

The experimental group included 21 infants at risk for ASD at 14 months (12 boys and 9 girls). The control group included 21 typically developing children. The children from groups were matched for gender and age. The Bayley Scales (3rd Ed.) were used to evaluate the neurocognitive abilities in children.

The results were evaluated by two-way ANOVA, with level of performance in five Bayley scales as dependent variable, with group and gender as between-subjects factors. We did not reveal the significant (p≤0,05) influence of the group and gender on performance in cognitive scale, receptive language, gross and fine motor. However, the infants at risk for ASD performed significantly (p≤0,05) more poorly than infants from control group on expressive language. No differences were found between female infants at risk for ASD and female infants from control group on expressive language.

The obtained results show that male infants at risk for ASD have deficit in expressive language at 14 months of age. It is possible that delay in development of expressive language can be early markers for ASD.

Harm reduction (HR) approaches substance use disorders (SUDs) from a standpoint of humanism and tolerance, understanding the difficulty of terminating consumption in some cases, and instead promoting practices aimed at reducing risks inherent to substance use while granting accessibility to comunity based healthcare and contact with differentiated care, when needed, to patients who otherwise wouldn’t have access to it. The COVID-19 pandemic brought about an economic crises, impacting mainly people from lower classes, associated with an increased prevalence of heroine and crack cocaine use and exacerbating previous SUDs.

Describe changes in a HR population treated in HR context in Gaia, Portugal.

Data was retrieved from clinical files of patients undergoing treatment in a Harm Reduction setting on the HR team “GiruGaia” from Porto. Analysed data included number of patients admitted to treatment in the period between march the 1st and december the 30th 2020, their sociodemographic data, psychiatric and substance use history, psychiatric treatment and opioid agonist treatment when required. Gathered data was compared to the same time period in previous years.

The number of patients admitted to treatment drastically increased. Patients presented with poorer socioeconomic conditions, more psychiatric comorbidity and in need of more extensive treatment interventions.

Our findings suggest that the pandemic and it’s socioeconomic impact affected drug users in need of HR interventions worsening underlying psychiatric disorders, poverty and inacessibility to healthcare. Drug users are often a forgotten population, and our results indicate that more attention should be devoted to them.

No significant relationships.

Social media use has grown exponentially over the past few years, having a key role in communication among our youngsters. The impact of social media in mental health is still unclear. While some studies advocate that it increases social support and general satisfaction, others associate social media with the development of mental health issues. Social media can also perform some pressure regarding body image and eating behavior, caused by the idealistic appearance shown there in a very visual way.

This review intends to identify the existing evidence regarding social media use, its impact on body image and eating behavior.

Search performed on May 11, 2020, including articles published since January 1st, 2006, written in Portuguese, English, Spanish and French. We used the MeSH terms ‘Body dissatisfaction’, ‘Body image’, ‘Feeding and eating disorders’, ‘Eating behaviors’ and ‘Social media’. The quality and strength of recommendation of the articles were evaluated using the Strength of Recommendation Taxonomy (SORT) scale from the American Academy of Family Physicians.

716 articles were initially found. Eight were selected: two systematic reviews, three cohort studies, two cross-sectional studies and one observational study.

This review presents studies that establish a correlation between social media use, body image dissatisfaction and disordered eating. However, methodological and population heterogeneity can compromise the conclusions observed. With the current evidence, we can conclude that there is a relationship between the use of social media and changes in body image and/or eating behaviors in adolescents and young adults (SORT B).

No significant relationships.

Violence in intimate relationships is a prevalent worldwide health problem and it is underreported, underrecognized and underadressed by health care professionals.This problem affects women more commonly than men and occurs in heterosexual and same-sex relationships. Violence can include physical, emotional, sexual and financial abuse, as well as control over contraception or pregnancy and medical care and it tends to be repetitive, with an escalation in frequency and severity over time. Abused patients exhibit chronic physical and emotional symptoms and injuries resulting from physical and sexual violence.

We conducted a review on violence in intimate relationships and the impact on mental health of the victims.

Comprehensive search of literature in the medical databases MEDLINE, PsycINFO, SciELO using the keywords: women, violence, intimate relationship violence, mental health, self injury.

Research has established a relationship between violence and mental health outcomes among women and girls. Violence or inter-personal trauma render women vulnerable to a range of psychiatric symptoms - depression, post-traumatic stress disorder (PTSD), suicide, and substance use are most common. Women reporting bidirectional violence had higher rates of depression and PTSD. When examining differences in rates of psychiatric disorders by the type of violence, it was found that all types of violence were strongly associated with all types of psychiatric disorders. Severity of psychiatric symptoms increased stepwise with increasing severity of violence.

Caring for patients in abusive relationships can be challeging - continuous supportive care improves patient outcomes. Physicians shoul be able to recognize and manage this situations in order prevent its negative outcomes.

There is a limited literature available showing mental health burden among adolescents following cyberbullying.

Aim is to evaluate the association of low mood and suicidality amongst cyberbullied adolescents.

A study on CDC National Youth Risk Behavior Surveillance (YRBS) (1991-2017). Responses from adolescence related to cyberbullying and suicidality were evaluated. Chi-square and mix-effect multivariable logistic regression analysis was performed to find out the association of cyberbullying with sadness/hopelessness, suicide consideration, plan, and attempts.

A total of 10,463 adolescents, 14.8% of adolescents faced cyberbullying a past year. There was a higher prevalence of cyberbullying in youths aged 15-17 years (25 vs 26 vs 23%), which included more females to males (68 vs 32%).(p<0.0001) Caucasians (53%) had the highest number of responses to being cyberbullied compared to Hispanics (24%), African Americans (11%).(p<0.0001) There was an increased prevalence of cyberbullied youths with feelings of sadness/hopelessness (59.6 vs 25.8%), higher numbers considering suicide (40.4 vs 13.2%), suicide plan (33.2 vs 10.8%), and multiple suicidal attempts in comparison to non-cyberbullied.(p<0.0001) On regression analysis, cyberbullied adolescence had a 155% higher chance of feeling sad and hopeless [aOR=2.55; 95%CI=2.39-2.72], considered suicide [1.52 (1.39-1.66)], and suicide plan [1.24 (1.13-1.36)].

In our study, cyberbullying was associated with negative mental health outcomes. Further research is warranted to examine the impact and outcomes of cyberbullying amongst adolescents and guiding the policies to mitigate the consequences.

No significant relationships.

Suicidal behaviour and cognition: A systematic review with special focus on prefrontal deficits Introduction: Suicide is a major health concern worldwide, thus, identifying risk factors would enable a more comprehensive understanding and prevention of this behaviour. Neuropsychological alterations could lead to difficulties in interpreting and managing life events resulting in a higher risk of suicide.

Objective: Bibliographic review about the influence of neuropsychological deficits on suicidal behaviour.

Method: A systematic literature search from 2000 to 2020 was performed in Medline (Pubmed), Web of Science, SciELO Citation Index, PsycInfo, PsycArticles and Cochrane Library databases regarding studies comparing cognition of attempters versus non-attempters that share same psychiatric diagnosis. Results: 1.885 patients diagnosed with an Affective Disorder (n = 1512) and Schizophrenia/ Schizoaffective Disorder (n = 373) were included.

In general comparison, attention was found to be clearly dysfunctional. Regarding diagnosis, patients with Schizophrenia and previous history of suicidal behaviour showed a poorer performance in executive function. Patients with current symptoms of an Affective Disorder and a previous history of suicidal attempt had poorer performance in attention and executive function. Similarly, euthymic affective patients with history of suicidal behaviour had worse decision-making, attention and executive function performance compared to euthymic non-attempters.

Patients who have attempted suicide have a poorer neuropsychological functioning than non-attempters with a similar psychiatric disorder in attention and executive function. These alterations increase vulnerability for suicide.

Jessica Fernández-Sevillano is beneficiary of the Pre-PhD Training Programme of the Basque Government. Dr. Gonzalez-Pinto has received grants and served as consultant, advisor or CME speaker for the following entities: Almirall, AstraZeneca, Bristol-Myers

Suicide is one of the major public health concerns worldwide, currently listed as the 15th most common cause of death. Mental illness stigma may contribute to suicidality and is associated with social isolation and low self-esteem among people with affective disorders.

The aim of the present study is to assess, in a sample of people with affective disorders, whether high levels of internalized stigma are associated to suicidal thoughts and behaviours.

60 outpatients diagnosed with depression or bipolar disorder according to DSM-5 have been recruited. Suicidal behaviours and ideation were assessed through the Columbia Suicide Severity Rating Scale (C-SSRS); internalized stigma through the Internalized Stigma of Mental Illness (ISMI) scale. Socio-demographic characteristics have been collected through an ad hoc schedule.

62.9% of the sample was female, with a mean age of 45.7 (±14) years. About half of the sample had a diagnosis of major depression (54.8%). Patients with suicidal ideation reported higher score at ISMI “alienation” subscale (p<0,05), compared to those without suicidal ideation. Patients with a previous history suicide attempts reported higher score at “alienation” and “social withdrawal” ISMI subscales (p<0,05). Moreover, “alienation” ISMI subscale significantly correlated with suicidal ideation and behaviours (p<0,01).

These results are in line with the available literature, highlighting that stigma and suicidality are strongly correlated. This underline the importance of interventions at addressing internalizing stigma, in particular to those with previous suicidal attempts and with an active suicidal ideation.

No significant relationships.

Though schizophrenia (SZ) and obsessive-compulsive disorder (OCD) are conceptualized as distinct clinical entities, they do have notable symptom overlap and a tight association. Graph-theoretical analysis of the brain connectome provides more indicators to describe the functional organization of the brain, which may help us understand the shared and disorder-specific neural basis of the two disorders.

To explore the static and dynamic topological organization of OCD and SZ as well as the relationship between topological metrics and clinical variables.

Resting state functional magnetic resonance imaging data of 31 OCD patients, 49 SZ patients, and 45 healthy controls (HC) were involved in this study (Table 1). Using independent component analysis to obtain independent components (ICs) (Figure 1), which were defined as nodes for static and dynamic topological analysis.

Static analysis showed the global efficiency of SZ was higher than HC. For nodal degree centrality, OCD exhibited decreased degree centrality in IC59 (located in visiual network) (P = 0.03) and increased degree centrality in IC38 (located in salience network) (P = 0.002) compared with HC. Dynamic analysis showed OCD exhibited decreased dynamics of degree centrality in IC38 (P = 0.003) compared with HC, which showed a negative correlation with clinical scores in OCD. While SZ showed decreased dynamics of degree centrality in IC76 (located in sensory motor network) compared with OCD (P=0.009), which showed a positive correlation with clinical scores in SZ (Figure 2).

These changes are suggestive of disorder-specific alternation of static and dynamic brain topological organization in OCD and SZ.

The 2019 Coronavirus disease epidemic is a public health emergency of international concern and poses a challenge to psychological resilience.

To study the psychological repercussions in terms of anxiety and depression of the Coronavirus pandemic on the Tunisian population.

This was a cross-sectional, descriptive and analytical study. We used an online questionnaire on Facebook, on June 2020. The heteroquestionnaire included epidemiological data and two scales: the State-Trait Anxiety Inventory (STAI Form Y-1) to evaluate the anxiety level at the time of the study, and the Patient Health Questionnaire (PHQ 9) to detect a characterized depressive episode.

We included 121 participants. They had an average age of 36.52 years with a sex ratio (M/F) of 0.41. The mean STAI score was 43.12 while the PHQ score was 7.46, indicating that 30.8% of the participants suffered from depression. Both scores were correlated to female sex (p=0.01 for STAI and p=0.02 for PHQ), a history of anxiety (p<0.001) and depressive disorders (p<0.001) and to poor sleep quality (p<0.001). The STAI score was also associated with a family history of high blood pressure (p=0.004), while the PHQ score was correlated to a family history of diabetes (p=0.02), a widowed or divorced marital status (p<0.001) and to a single lifestyle (p=0.03). Furthermore, the two scores (STAI-Y and PHQ 9) were also associated (p<0.001; r=0.67).

The psychological impact of Coronavirus epidemic seems not negligible requiring psychological interventions to improve the mental health of vulnerable groups.

Patients with OCD often show unsatisfactory response to first-line treatment, giving rise to a need for novel therapeutic approaches. Recent studies using tDCS for OCD treatment have shown promise.

To assess efficacy and safety of add-on c-tDCS over pre-SMA compared to sham stimulation in patients with OCD.

In this double-blinded study, fourteen patients with OCD were randomized to receive 10 sessions of either active (Cathode over pre-SMA, anode over right deltoid, 2mA, 20 minutes per session, 2 sessions per day, 2 hours apart) or sham tDCS. YBOCS, HAM-D, HAM-A, CGI, Wisconsin Card Sorting Test (WCST), and Stroop Test were administered at baseline, post-tDCS, and 1 month post-tDCS.

Group×time interaction effect for YBOCS scores with Repeated Measures ANOVA was not statistically significant, however, reduction in scores in active group was higher, with large effect size (YBOCS scores: Obsessions-ηp2=.344, Compulsions-ηp2= .384, Total-ηp2=.392) (Fig.1 & 2). At 1 month, 42.9% patients in active group and none in sham group showed response. CGI-S score (p=0.016, ηp2=.531) (Fig. 3) and four parameters of WCST (Perseverative responses:p=0.038, ηp2=.448;Percent perseverative responses:p=0.026, ηp2=.485;Percent perseverative errors:p=0.038, ηp2=.447;Trials to complete first category:p=0.011, ηp2=.563) significantly reduced in active group. No significant difference in change in depressive and anxiety symptoms between groups, or change in Stroop Test performance was noted. Adverse effects included transient headache and tingling sensation.

Cathodal tDCS over pre-SMA may be effective in reduction of obsessions, compulsions, illness severity, and enhancing cognitive flexibility in patients with OCD, with no major adverse effects. Larger studies are required to confirm these findings.

No significant relationships.

Natural caregivers of patients with schizophrenia are often subjected to stigma by virtue of their association with patients. Affiliate stigma expose caregivers to community rejection, isolation and may have a negative impact on their psychological wellbeing.

This study aimed to assess perceived stigma and burden in a Tunisian population of natural caregivers of patients with schizophrenia and to identify risk factors for developing such disorders.

We conducted a cross-sectional, descriptive and analytical study, including 80 natural caregivers of patients with schizophrenia. We used the Stigma Devaluation Scale (SDS) to assess stigma and the Zarit Burden Interview (ZBI) to evaluate burden.

The average age of natural caregivers was 55.7 years. The sex ratio (M/F) was 0.86. The mean score of perceived stigma in patients was 24.7. That of perceived stigma in caregivers was 15.34. Assessing the burden on caregivers estimated an average score of 58, corresponding to a severe burden. Medium to high burden was found in 78% of participants. Perceived stigma scores were significantly higher among illiterate caregivers, those linking schizophrenia to hereditary causes, among parents, and in case of daily contact with the patient. Scores of perceived stigma in caregivers were also significantly correlated with burden score.

Natural caregivers of patients with schizophrenia are exposed to affiliate stigma and experience an important level of burden. Our findings emphasize the need to support natural caregivers of persons with schizophrenia and to develop strategies to combat stigmatization among patients as well as their natural caregivers.

Akiskal proposed the bipolar spectrum concept with the aim of including those patients with atypical depressive presentations and mood temperaments. Also Koukopoulos accepted this proposal in those patients with poor response to antidepressants or highly recurrent course. Concretely bipolar disorder type IV was defined as clinical depression based on a lifelong hyperthymic temperament. Some years after DSM-III several experts in bipolar disorder continued in this work line even though DSM-IV and most recent DSM-V not considered to include this concept as a new diagnostic category.

To present a theoretical and practical review about bipolar spectrum and its relationship with hyperthymic traits.

We carry out a literature review about bipolar spectrum, accompanied by the clinical description of one patient with major depressive disorder and hyperthymic traits base.

45 years old female referred to our outpatient mental health service after episode of voluntary drug overdose. She presented long evolution depressive symptoms (sadness, apathy, anhedonia, anergy, irritability, anxiety, emotional lability, early awakening, social withdrawal, self-care neglect, hopelessness, cognitive failures, guilt feelings and death ideas) with onset in postpartum. She reported a previous depressive episode 9 years ago with good response to fluoxetine. Hyperthimic traits were described but no history of manic symptoms. An erratic evolution was observed with various antidepressant treatment and finally improved adding mood stabilizer.

We must propose to consider the diagnosis of bipolar spectrum in order to treat effectively patients with major depression dissorder and hyperthymic temperament in absence of manic symptoms.

No significant relationships.